Clinical determinants of hospital treated deliberate self-harm repetition: A time to recurrent event analysis.

INTRODUCTION: Psychiatric disorders are strongly associated with hospital treated deliberate self-harm (DSH). However, the effect of specific disorders on risk for DSH repetition in sex-age-subgroups is understudied. The present study aims to assess the influence of various specific psychiatric disorders on risk for subsequent DSH repetition by way of time to recurrent event analysis on a national cohort of DSH patients. MATERIAL AND METHODS: Individuals aged 18 and older presenting to somatic hospital for DSH during the period 2008-2018 was identified through national registers. A parametric shared frailty survival analysis was used to investigate the impact of various psychiatric disorders on risk of DSH repetition. RESULTS: The cohort consisted of 39,508 individuals of which 8634 (21.8%) presented with 24,028 repeated episodes of hospital treated DSH. Borderline personality disorder increased the risk of DSH repetition in females (adjusted HR 1.49, CI 1.41-1.57), while alcohol use disorder (HR 1.12, CI 1.04-1.19) and substance use disorders (adjusted HR 1.22, CI 1.14-1.32) increased the risk of repetition in males. The strongest impact of psychiatric disorder on risk of repetition was found among the elderly. Previous history of DSH was associated with the highest increased risk of repetition. CONCLUSION: Prior history of DSH was strongly associated with DSH repetition, but the influence of psychiatric disorder varied significantly by specific diagnoses and by sex and age of the patients. Efforts to prevent DSH repetition should be age and gender specific and designed to meet the needs of people with different specific psychiatric disorders.

Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry.

BACKGROUND: Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. METHODS: Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10-19 years who were treated for self-poisoning with medication during 2008-2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. RESULTS: 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. CONCLUSION: Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.

Psychiatric disorders among adults treated for deliberate self-harm in general hospital: A national register study.

BACKGROUND: Psychiatric disorders are common among individuals treated for deliberate self-harm (DSH) in general hospitals. However, few large-scale studies have explicitly addressed psychiatric disorders among adult DSH patients. AIM: To examine the presence of psychiatric disorders among adults presenting to general hospitals following DSH, and further to establish clinical and sociodemographic determinants of being diagnosed with a psychiatric disorder in this patient population. METHOD: Data from several national registers were interlinked to identify all individuals aged 18 and older presenting to general hospital for DSH during the period 2008-2018. Logistic regression was used to examine the association between psychiatric disorders (ICD-10) and clinical and sociodemographic characteristics of the DSH patients. RESULTS: Altogether 39,534 subjects with 63,622 episodes of DSH were included in the study with a gender ratio (F:M) of 1.48. The majority were unmarried and had low income and education. Psychiatric disorders were present in 58.5 % of all episodes and in 54.3 % of the index episodes. Affective disorders displayed the highest prevalence (18.3 %), followed by alcohol use disorder (16.4 %). Personality disorders were highly prevalent among young females with multiple DSH episodes. Middle-aged individuals had the highest prevalence of psychiatric disorders. Presence of psychiatric disorders was significantly associated with DSH repetition. LIMITATIONS: Data was restricted to variables available in the registers. CONCLUSIONS: Psychiatric disorders were common among DSH patients in the present cohort, but distributed differently between the genders. DSH repetition and middle-age was associated with being diagnosed with a psychiatric disorder.